Blocking of health information undermines health system interoperability and delivery reform

The secure, appropriate, and efficient sharing of electronic health information is the foundation of an interoperable learning health system—one that uses information and technology to deliver better care, spend health dollars more wisely, and advance the health of everyone.

Today we delivered a new Report to Congress on Health Information Blocking that examines allegations that some health care providers and health IT developers are engaging in “information blocking”—a practice that frustrates this national information sharing goal.

Health information blocking occurs when persons or entities knowingly and unreasonably interfere with the exchange or use of electronic health information. Our report examines the known extent of information blocking, provides criteria for identifying and distinguishing it from other barriers to interoperability, and describes steps the federal government and the private sector can take to deter this conduct.

This report is important and comes at a crucial time in the evolution of our nation’s health IT infrastructure. We recently released the Federal Health IT Strategic Plan 2015 – 2020 and the Draft Shared Nationwide Interoperability Roadmap. These documents describe challenges to achieving an interoperable learning health system and chart a course towards unlocking electronic health information so that it flows where and when it matters most for individual consumers, health care providers, and the public health community.

While most people support these goals, some individual participants in the health care and health IT industries have strong incentives to exercise control over electronic health information in ways that unreasonably interfere with its exchange and use, including for patient care.

Over the last year, ONC has received many complaints of information blocking. We are becoming increasingly concerned about these practices, which devalue taxpayer investments in health IT and are fundamentally incompatible with efforts to transform the nation’s health system.

The full extent of the information blocking problem is difficult to assess, primarily because health IT developers impose contractual restrictions that prohibit customers from reporting or even discussing costs, restrictions, and other relevant details. Still, from the evidence available, it is readily apparent that some providers and developers are engaging in information blocking. And for reasons discussed in our report, this behavior may become more prevalent as technology and the need to exchange electronic health information continue to evolve and mature.

There are several actions ONC and other federal agencies can take to address certain aspects of the information blocking problem. These actions are outlined in our report and include:

  • Proposing new certification requirements that strengthen surveillance of certified health IT capabilities “in the field.”
  • Proposing new transparency obligations for certified health IT developers that require disclosure of restrictions, limitations, and additional types of costs associated with certified health IT capabilities.
  • Specifying a nationwide governance framework for health information exchange that establishes clear principles about business, technical, and organizational practices related to interoperability and information sharing.
  • Working with the Centers for Medicare & Medicaid Services to coordinate health care payment incentives and leverage other market drivers to reward interoperability and exchange and discourage information blocking.
  • Helping federal and state law enforcement agencies identify and effectively investigate information blocking in cases where such conduct may violate existing federal or state laws.
  • Working in concert with the HHS Office for Civil Rights to improve stakeholder understanding of the HIPAA Privacy and Security standards related to information sharing.

While these actions are important, they do not provide a comprehensive solution to the information blocking problem. Indeed, the most definitive finding of our report is that most information blocking is beyond the current reach of ONC or any other federal agency to effectively detect, investigate, and address. Moreover, the ability of innovators and the private sector to overcome this problem is limited by a lack of transparency and other distortions in current health IT markets.

For these and other reasons discussed in our report, addressing information blocking in a comprehensive manner will require overcoming significant gaps in current knowledge, programs, and authorities. We believe that in addition to the actions above, there are several avenues open to Congress to address information blocking and ensure continued progress towards the nation’s health IT and health care goals.

Information blocking is certainly not the only impediment to an interoperable learning health system. But based on the findings in our report, it is a serious problem—and one that is not being effectively addressed. ONC looks forward to working with Congress, industry, and the health IT community to properly address this problem and ensure continued progress towards achieving the goals of an interoperable learning health system.

6 Comments

  1. Frank Poggio says:

    ONC contiues to ignore the required first step needed to get to effective interoperability.
    One reason why interop is so difficult and costly is that vendors have to jury-rig their systems to make sure that foriegn systems are looking at the very same person /patient.

    Without a unique person identifier (which I know was forbidden by Congress in 1996 as part of HIPAA) you are requireing vendors to put Rube Goldberg processes together. This takes time, money and makes things very difficult. Then when a vendor says it will cost big dollars to install and make sure the interop process works porperly…providers and ONC call it INFORMATION BLOCKING!

    My solution to this political problem (it surely is not a technical one) is to have an opt-in /opt-out choice selected by each person. Not unlike the new TSA Trusted Traveler program. If a citizen wants to keep his/her ID private, that’s fine, but don’t expect to get your health records follow you on your drive across country.

    I have been in the health care IT industry for some 45 years, and if there is one thing I have learned it is that politics makes for terrible system design.

  2. meltoots says:

    I think its very important to separate out what you mean by “providers”. Front line physicians (EPs) have NO interest in nor any capability to block interoperability. “Providers” to the lay person and congressional folks means doctors. Its not the doctors. Certainly EHR vendors and certain EHs are info blockers. Its about time all of you at ONC start listening to front line providers. It has become apparent that you are tone deaf to our problems with these programs. ONC should not be requiring ANY certification for participation in these programs. The remaining EHR vendors are going to push for the highest hurdles to get in the game and ONC appears to be listening. We need innovation, we need EHR companies to listen to front line EPs not ONC. We need usability safety security and efficiency, which includes interop. When you have no threat of innovation or new blood, then they will be huge barriers placed for interop, from design to financial. Certainly some EHs want to protect their turf and do not want anyone accessing their data. Please though, stop asking the sycophant EPs out there about MU, interop, PQRS/VBM, ICD-10. Ask REAL front line providers. We are overwhelmed, overburdened, clicked to death, and the vast majority are quitting all these programs, which will do nothing to improve your dream of smooth interop. We are barely surviving the current requirements of MU and Stage 2 killed us. Stage 3 rule is burying the body. The 2015 ONC cert is just making matters worse. Is there anyone out there listening?

  3. meltoots says:

    I think its very important to separate out what you mean by “providers”. Front line physicians (EPs) have NO interest in nor any capability to block interoperability. “Providers” to the lay person and congressional folks means doctors. Its not the doctors. Certainly EHR vendors and certain EHs are info blockers. Its about time all of you at ONC start listening to front line providers. It has become apparent that you are tone deaf to our problems with these programs. ONC should not be requiring ANY certification for participation in these programs. The remaining EHR vendors are going to push for the highest hurdles to get in the game and ONC appears to be listening. We need innovation, we need EHR companies to listen to front line EPs not ONC. We need usability safety security and efficiency, which includes interop. When you have no threat of innovation or new blood, then they will be huge barriers placed for interop, from design to financial. Certainly some EHs want to protect their turf and do not want anyone accessing their data. Please though, stop asking the sycophant EPs out there about MU, interop, PQRS/VBM, ICD-10. Ask REAL front line providers. We are overwhelmed, overburdened, clicked to death, and the vast majority are quitting all these programs, which will do nothing to improve your dream of smooth interop. We are barely surviving the current requirements of MU and Stage 2 killed us. Stage 3 rule is burying the body. The 2015 ONC cert is just making matters worse. Is there anyone out there listening? Oh I forgot, just ask real providers about the real hurdles to interop. You will find the answers. I can give you a really good example, today someone showed up to our ED in septic shock, we are a community hospital . He had bilateral TKA infections. He underwent many treatments at Healthspan/Kaiser in our town. I could not get ANY information about his treatments, care, or ANYTHING. I tried calling to get any information, and it was nightmare to actually find a human. Even then, I got nowhere. I could only get partial information from his wife who accompanied him. That is interop 2015.

  4. Paul shapin says:

    Seems that the congressional ban on creating a national patient identifier is one of the largest systemic blocker of information exchange.

  5. Eric Adams says:

    I am so glad this thing bubbled up. HIE would be a lot farther along if ONC had some kind of policy on this, forcing all players to share data in a standard way and at set prices. Epic (the bad guys) by the way charges just $1.35 for a full CCD extract and transfer out. If every other EMR did that much we would be enjoying the hundreds of billinons in HIE driven savings today 🙂

    Here is how one major national EMR vendor engaged in information blocking just several weeks ago. As per their website they have a simple API interface that enables the transfer of charge capture (ICD,CPT,DEMOGR,INS) data set for processing in third party billing systems. When contacted they informed that there is a $10,000 implementation fee in addition to per claim fees. I think that’s information blocking by unreasonable pricing.

    To put things in perspective Medicare and Medicaid charge NOTHING to set up and fully test direct submitters engaging in a lot more sophisticated exchange of 837/835 revenue cycle EDI files. Clearinghouse Emdeon being a commercial entity charges $500 for the same thing, a perfectly reasonable amount considering some exchange partners will need more handholding than others. BUT $10,000 for an interface that has 10% of the functionality of a full HIPAA EDI transactional interface is highway robbery and a perfect example of information blocking by unreasonable pricing.

  6. John Dodd says:

    Add a few questions to the Hospital Reporting, PQRS, and the specialty reports about enablers and barriers to interoperability and you can have a great deal of information.
    Also the current design of the HIE’s with their state or regional nature are roadblock and InterCloud approach to interoperability can be used. The HIE idea was good in 2005 but not 2015. Your outreach effort can create Partner Community Clouds based on disease foundations, next generation ACO’s and using Medicare and Medicaid. Describe an approach in the new book I am writing leveraging other ultra large scale experience in government and other industries.
    Cheers
    John Dodd

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